Biomedical subjects

L Adolfsson

Publications and source records attributed to L Adolfsson.

At least 19 recordsLinked to original sources

PubMed2004

Arthroscopic findings in wrists with severe post-traumatic pain despite normal standard radiographs.

This study assessed the role of diagnostic arthroscopy following a wrist injury in patients with normal standard radiographs, an unclear clinical diagnosis and persistent severe pain at 4 to 12 weeks. Forty-three patients were included after conservative management had failed to improve their wrist pain so that a stability test could be performed satisfactorily and underwent arthroscopy within 12 weeks. Arthroscopy revealed recent pathology in 41 wrists, of which 17 had significant ligament lesions that might have benefited from acute repair. We conclude that patients with marked persistent post-traumatic symptoms despite conservative management are likely to have sustained ligament injuries despite normal radiographs. We therefore recommend that under these circumstances an arthroscopy is carried out within 4 weeks if the patient and surgeon wish to acutely repair significant ligament injuries.

Adolescent↗

PubMed2001

Non-operative treatment regime including eccentric training for lateral humeral epicondylalgia.

In a pilot study 38 patients with lateral humeral epicondylalgia were randomly allocated to two treatment groups. Group S (stretching) was treated with a contract-relax-stretching program while group E (eccentric exercise) underwent an eccentric exercise program. Both groups also received forearm bands and wrist support nightly. The programs were carried out daily at home during 12 weeks. Evaluation before and 3, 6 and 12 months after treatment, included subjective assessment of symptoms using visual analogue scales and grip strength measurements. Thirty-five patients were available for follow-up. Five patients, three in group S and two in group E, did not complete the programs due to increased pain while 30 (86%) reported complete recovery or improvement. Reduced pain and increased grip strength were seen in both treatment groups but 12 out of 17 patients (71%) in group E rated themselves as completely recovered as compared to 7 out of 18 (39%) in group S (P=0.09), and in group E the increase in grip strength after 6 months was statistically significantly larger than in group S. In a second study the eccentric training regime was used in a consecutive series of 129 patients with lateral epicondylalgia. The patients were divided into two groups with one group consisting of patients with less than one year duration of symptoms and the other comprised patients with a duration of symptoms for more than one year. The results of treatment were evaluated in the same way as in the pilot study, and also after 3.4 years using the scoring system by Verhaar et al. At the end of the treatment period statistically significant improvements were seen in all VAS recordings and in grip strength. After 3.4 years 38% had excellent, 28% good, 25% fair and 9% poor results according to the score. In the self-rated outcome 54% regarded themselves as completely recovered, 43% improved, 2% unchanged and 2% worse. No significant differences were seen between patients with a duration of symptoms for more than one year compared to patients with symptoms for less than one year. The eccentric training regime can considerably reduce symptoms in a majority of patients with lateral humeral epicondylalgia, regardless of duration, and is possibly superior to conventional stretching.

Adult↗

PubMed2001

Acutrak screw fixation versus cast immobilisation for undisplaced scaphoid waist fractures.

Fifty-three patients with less than 14 day-old, undisplaced fractures of the waist of the scaphoid were randomized to two groups. Twenty-eight patients were treated by immobilisation in a below elbow plaster cast for 10 weeks while 25 were treated by percutaneous insertion of an Acutrak standard screw. There were no statistically significant differences between the two treatment groups with regard to either the rate of union or the time to union. Patients who underwent surgery had a significantly better range of motion at 16 weeks but there were no significant differences for grip strength. Acute percutaneous internal fixation of undisplaced scaphoid waist fractures using the Acutrak screw allows early mobilisation without adverse effects on fracture healing.

Adolescent↗

PubMed2001

Different effect on axonal outgrowth of application of non-absorbable or absorbable tubes around a nerve repair.

We studied regeneration distance of rat sciatic nerve, with the sensory pinch reflex test and immunocytochemical staining for neurofilaments, four to 21 days after transsection, repair, and enclosure of the repair site in either a non-absorbable silicone tube or an absorbable polyglycolic acid (PGA) tube. The size of both tube-types was carefully selected so that they did not compress the repaired nerve. The opposite nerve was repaired and not inserted in a tube (control). The regeneration distances in repaired nerves enclosed in silicone tube were significantly longer than the control side at all time points, a result not seen when PGA tube was used. The number of proliferating non-neuronal cells (incorporation of 5-bromodeoxyuridine (BrdU)) was studied just proximal to the site of nerve repair after six days. Numerous stained cells were seen, but there where no significant differences between the groups. We conclude that outgrowth of sensory axons after transsection and repair of rat sciatic nerve with sutures can be increased by enclosing the site of repair in a silicone tube but not in a PGA tube. The effect is probably not related to the number of proliferative non-neuronal cells.

Absorbable Implants↗

PubMed1999

Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture.

Arthroscopic debridement and capsular release was performed in a 57-year-old woman because of post-traumatic stiffness in the dominant right elbow joint. During this procedure, the median and radial nerves were completely transected. A few recent reports of small series have described encouraging results after arthroscopic capsular release of post-traumatic elbow contracture, but the present case demonstrates the inherent risk of damage to neurovascular structures.

Accidental Falls↗

PubMed1999

4.5 year follow-up after surgical correction of upper extremity deformities in spastic cerebral palsy.

Reconstructive surgery was carried out on 27 upper extremities in 24 children with deformities due to spastic cerebral palsy. Functional evaluation of the affected extremities was made preoperatively, at 6 months and at a mean of 4.5 years postoperatively using a score added to the assessment system described by the Committee on Spastic Hand Evaluation. According to the score, dysfunction of the arm was significantly reduced 6 months after the reconstructive surgery and the improvements remained essentially unchanged at the later follow-up. The addition of a score to the original assessment system facilitated the overall assessment of postoperative results.

Adolescent↗

PubMed1999

Attitudes toward management of patients with subacromial pain in Swedish primary care.

OBJECTIVE: We aimed to describe the attitudes among GPs and physiotherapists toward the diagnostic approach and management of patients with a common shoulder disorder. METHOD: A questionnaire was sent out to 188 GPs and 71 physiotherapists. The total response rate was 71.8%. The questions were based on a written case simulation with cues about history and symptoms. RESULTS: The results showed a unanimous opinion of the diagnosis. Rotator cuff tendinitis was marked as the most probable. The two groups showed similarities in the way that they would examine the patient. The GPs referred the patients to the physiotherapists significantly more often than the other way around. The most probable choice of treatment made by the GPs was non-steroidal anti-inflammatory drugs (NSAIDs) and by the physiotherapists, movement exercises together with ergonomics. Most treatment alternatives had at least 20% of the responders marking a neutral attitude, and few treatments were disregarded. CONCLUSIONS: We conclude that in Swedish primary care GPs and physiotherapists have a uniform diagnostic approach towards patients with subacromial pain, but their choice of treatment reflects an uncertainty about the effectiveness of conservative treatments. The questioned pathogenesis of the suggested diagnosis and lack of research regarding the efficacy of conservative treatments could explain this uncertainty.

Adult↗

PubMed1998

Arthroscopically-assisted reduction of intra-articular fractures of the distal radius.

Twenty-seven patients with intraarticular fractures of the distal radius with a step of more than 1 mm in the joint surface after attempted closed reduction, were treated by reduction under arthroscopic control and percutaneous fixation. All fractures healed without measurable incongruity of the joint surface and at follow-up 3 to 38 months after surgery 19 patients had excellent and eight patients good results according to the Mayo modified wrist score.

Adolescent↗

PubMed1997

Touch allodynia following endoscopic (single portal) or open decompression for carpal tunnel syndrome.

We investigated if single-portal endoscopic carpal tunnel decompression equipment (Agee, 3M, USA) would cause increased carpal tunnel pressure during the release and if endoscopic release would reduce postoperative touch allodynia. Measurements on cadavers of the pressure produced during endoscopic release showed similar pressures to those produced during maximal range of motion. One hundred patients underwent either open or endoscopic decompressions. Twenty normal individuals served as controls. At 1 month after surgery both groups had significant allodynia compared with the controls, but at 3 months the endoscopic group had returned to normal though the open group was still significantly abnormal. The reported endoscopic release may therefore be of particular advantage to patients who would seriously be disadvantaged if postoperative touch allodynia should develop. The Agee endoscope is unlikely to cause disturbance of the nerve function due to increased carpal pressure during the release.

Carpal Tunnel Syndrome↗

PubMed1997

Arthroscopic synovectomy of the rheumatoid wrist. A 3.8 year follow-up.

Twenty-four wrists in 19 patients with rheumatoid arthritis affecting the wrist were treated by arthroscopic synovectomy. Range of motion, subjective pain, wrist function and X-ray changes were recorded preoperatively and at an average of 3.8 years after operation. Arthroscopic synovectomy of the rheumatoid wrist reduced pain and improved wrist function in the majority of patients. Progress of arthritic degeneration was significantly less common in patients with no, or very early changes at the time of surgery.

Arthritis, Rheumatoid↗

PubMed1996

The effects of a shortened postoperative mobilization programme after flexor tendon repair in zone 2.

The effects of a shortened post-operative mobilization programme following flexor tendon repair in zone 2 in the hand were examined in a prospective, randomized study. 91 digits in 82 patients were included in the study. All injured tendons were repaired within 24 hours and all patients were subjected to the same mobilization programme during the first 6 weeks using a passive flexion-active extension régime. After 6 weeks the patients were randomized into two groups; in group A full activity was allowed after 8 weeks while in group B unrestricted use of the injured hand was not allowed until 10 weeks after the tendon repair. Functional results were compared using the Louisville, Tsuge and Buck-Gramcko assessment systems. Grip-strength was measured 16 weeks after repair, subjective assessment of hand function was recorded on a visual analogue scale, and absence from work was registered. No significant differences were observed between the groups regarding functional results, rupture rates, grip strength or subjective assessment, but absence from work was reduced by 2.1 weeks with the shorter mobilization programme. Using the described régime, full activity can be encouraged 8 weeks after flexor tendon repair in zone 2 of the hand without adverse effects on functional results or increased risk of rupture of the repair.

Female↗

PubMed1994

Arthroscopic diagnosis of ligament lesions of the wrist.

144 patients with post-traumatic wrist pain but normal standard radiographs were examined by wrist arthroscopy. Ligamentous lesions were observed in 75 patients. TFCC lesions, classified according to the Palmer classification and including lunato-triquetral interosseous ligament lesions, were seen in 61, and scapho-lunate interosseous ligament lesions in 14 patients. Degenerative TFCC changes were equally common in patients younger than 40 years of age but significantly more common with more than 2 years duration of symptoms. Varying degrees of instability were noted in patients with scapho-lunate interosseous ligament lesions but no associated ligament lesions were observed. Because of the variety of pathological changes arthroscopy is recommended in the management of patients with post-traumatic wrist pain.

Adult↗

PubMed1993

Results of arthroscopic acromioplasty related to rotator cuff lesions.

Seventy-nine patients with a history of the subacromial impingement syndrome were treated by arthroscopic acromioplasty. The results were evaluated with a new scoring system designed to assess subjective symptoms before and after operation. The outcome was related to the pathological lesions of the rotator cuff seen at arthroscopy and graded by our modification of the Neer classification. The overall results were satisfactory in 67%, with men having better results than women. Those with a history of injury did better than those without, and the results in those with partial or total cuff tears were better than those with intact cuffs. Since the state of the cuff affects the result, arthroscopy should precede acromioplasty.

Acromion↗

PubMed1993

Arthroscopic synovectomy of the rheumatoid wrist.

18 wrists in 16 patients with synovitis due to rheumatoid arthritis were treated with arthroscopic synovectomy. The surgical procedure and the results after surgery are described. Range of motion, grip strength, subjective experience of pain and level of activity were registered pre- and post-operatively. The operations were found to give good pain relief, increased grip strength, no post-operative stiffness and a short period of rehabilitation.

Arthritis, Rheumatoid↗

PubMed1992

Arthroscopy for the diagnosis of post-traumatic wrist pain.

30 patients with post-traumatic wrist pain were investigated by arthroscopy. The clinical findings and type of injury were compared to the pathological morphology seen at arthroscopy. In 21 (70%) of the patients, arthroscopic findings gave a plausible explanation for the symptoms.

Adult↗

PubMed1991

Arthroscopy for the diagnosis of shoulder pain.

Arthroscopy under anaesthesia was used to investigate 123 patients with painful shoulders. The clinical diagnosis was compared with the arthroscopic findings. Four types of rotator cuff lesions were found in which there were significant differences between sex and age. Instability detected under anaesthesia was an important cause of pain. These examinations proved valuable in the diagnosis of shoulder pain, particularly when the clinical diagnosis was uncertain.

Adult↗

PubMed1989

Arthroscopy and stability testing for anterior shoulder instability.

The extreme manifestation of anterior shoulder instability is anterior dislocation. Minor anterior instability often gives rise to vague symptoms from which a diagnosis is difficult. The use of arthroscopy may increase diagnostic accuracy in cases of anterior shoulder instability. Examinations were performed on 145 patients with shoulder complaints using stability testing under anesthesia and arthroscopy; of these, 62 patients were found to have anterior shoulder instability. The clinical signs were compared with the findings on stability testing and arthroscopy, and the morphological changes noted on arthroscopy were recorded. The combination of arthroscopy and stability testing proved valuable in the diagnosis of minor anterior instability and for the morphological changes and associated injuries in established anterior dislocations.

Adult↗

PubMed1987

Antithrombin III binding to surface immobilized heparin and its relation to F Xa inhibition.

The mode of F Xa inhibition was investigated on a thromboresistant surface with end-point attached partially depolymerized heparin of an approximate molecular weight of 8000. Affinity chromatography revealed that one fourth of the heparin used in surface coating had high affinity for antithrombin III (AT). The heparin surface adsorbed AT from both human plasma and solutions of purified AT. By increasing the ionic strength in the AT solution the existence of high and low affinity sites could be shown. The uptake of AT was measured and the density of available high and low affinity sites was found to be in the range of 5 and 11 picomoles/cm2, respectively. Thus the estimated density of biologically active high and low affinity heparin respectively would be 40 and 90 ng/cm2. The heparin coating did not take up or exert F Xa inhibition by itself. With AT adsorbed on both high and low affinity heparin the surface had the capacity to inhibit several consecutive aliquots of F Xa exposed to the surface. When mainly high affinity sites were saturated with AT the inhibition capacity was considerably lower. It was demonstrated that the density of AT on both high and low affinity heparin determines the F Xa inhibition capacity whereas the amount of AT on high affinity sites limits the rate of the reaction. This implies that during the inhibition of F Xa there is a continuous surface-diffusion of AT from sites of a lower class to the high affinity sites where the F Xa/AT complex is formed and leaves the surface. The ability of the immobilized heparin to catalyze inhibition of F Xa is likely to be an important component for the thromboresistant properties of a heparin coating with non-compromised AT binding sequences.

Animals↗